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Vernon Street Medical Centre Good Also known as Dr P W Iddon and Partners

Inspection Summary


Overall summary & rating

Good

Updated 15 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Vernon Street Medical Centre on 22 July 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • The practice demonstrated an open and transparent approach to safety. There were systems in place to enable staff to report and record significant events. Learning from significant events was shared.
  • Risks to patients were assessed and well managed. A health and safety action plan was in place and risks were monitored on an ongoing basis.
  • Staff delivered care and treatment in line with evidence based guidance and local guidelines. Training had been provided for staff to ensure they had the skills and knowledge required to deliver effective care and treatment for patients.
  • Clinical audits were undertaken and showed improvements in the quality of care provided to patients.
  • Feedback from patients was that they were treated with kindness, dignity and respect and were involved in decisions about their care.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice proactively sought feedback from patients through the use of surveys and via the NHS Friends and Family Test.
  • Patients said they could generally get appointments when they needed one. There were systems in place to monitor demand for appointments and the practice continually sought to improve access for patients. A new telephone system was being installed in response to patient feedback.
  • There was a clear leadership structure which all staff were aware of. Staff told us they felt supported by the partners and management.
  • There was a clear vision and mission which was shared with patients on the website and throughout the practice.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

  • The provider should ensure that their business continuity plan is updated to formalise arrangements for dealing with major incidents or emergencies
  • The provider should strengthen their system to record actions taken to address infection control issues.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 September 2016

The practice is rated as good for providing safe services.

  • The practice had systems in place to enable staff to report and record significant events. Staff understood the systems and were encouraged to report events and incidents.
  • Learning from significant events was identified and shared to improve safety.
  • When things went wrong patients received support, information and apologies. They were told about actions to improve processes to prevent the same thing happening again.
  • Systems and processes were in place to ensure patients were kept safe and safeguarded from abuse. For example, there were processes in place to ensure medicines were managed safely within the practice. The practice had recently recruited two practice pharmacists who ensured that safe prescribing processes were in place within the practice.
  • Risks to patients were assessed and well managed across the practice. A health and safety action plan had been implemented and improvements made in a range of areas including updating policies and issuing staff with employee safety handbooks.
  • Two areas needed strengthening and these were updating their business continuity plan and strengthening records maintained of action taken to address infection control issues.

Effective

Good

Updated 15 September 2016

The practice is rated as good for providing effective services.

  • Systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines. Guidelines were discussed at regular clinical meetings and the practice had recently introduced educational meetings.
  • Clinical audits were undertaken within the practice and demonstrated improvement in the quality of clinical care.
  • Data showed that the practice was performing well when compared to other practices.
  • The practice had an overall exception reporting rate within QOF of 14.4% which was 3.3% above the CCG average and 5.2% above the national average. Exception reporting was carried out in line with guidance and we saw that there were measures in place to reduce exception reporting rates and to encourage as many patients as possible to attend for reviews.
  • Screening rates for cervical cancer, breast cancer and bowel cancer in line with local and national averages.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs. In addition to six-weekly community support team meetings, the practice held regular clinical meetings.

Caring

Good

Updated 15 September 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed some areas of positive performance. For example 97% of patients said they had confidence and trust in the last GP they saw compared to the CCG average of 96% and the national average of 95%.
  • A recent patient survey undertaken by the practice demonstrated that the vast majority of patients within the practice felt well cared for by GPs, nurses and reception staff.
  • Feedback from patients we spoke with and on completed comment cards was positive about the care provided by the practice. This aligned with feedback from local care and nursing homes.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality. We saw a number of examples of staff going the extra mile to support patients. For example, one of the GPs visited a patient who was nearing the end of their life on Christmas day to ensure continuity of care.
  • The practice had identified 6% of their patient population as carers and provided them with support and services such as flu vaccinations.

Responsive

Good

Updated 15 September 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of the local population and delivered services to meet their needs. For example, the practice offered nursing and health care assistant services to patients who were housebound.
  • A range of services were offered by the practice to avoid patients having to travel including minor surgery and joint injections.
  • Monthly ward rounds were carried out at nursing and care homes to ensure all patients were reviewed on a regular basis.
  • Patients said they were able make urgent appointments when required.
  • In response to patient feedback regarding telephone access, the practice was implementing a new telephone system.
  • The practice had adequate facilities and was equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 15 September 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. The practice’s vision was supported by a mission statement and areas of focus.
  • There was a clear leadership structure with senior staff having key areas of clinical responsibility.
  • Policies and procedures were in place to govern activity and the practice held regular partners’ meetings to review governance.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The partners and the practice manager encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
  • There was a focus on continuous learning and development with staff being encouraged to undertake training and develop their roles. The practice hoped to become a training practice in the future.
Checks on specific services

People with long term conditions

Good

Updated 15 September 2016

The practice is rated as good for the care of people with long-term conditions.

  • Clinical staff had lead roles in managing patients with long-term conditions and those patients identified as being at risk of admission to hospital were identified as a priority.
  • Performance for diabetes related indicators was 99.97% which was 6.9% above the CCG average and 10.8% above the national average.
  • Longer appointments and home visits were available when needed to facilitate access for these patients.
  • All these patients had a named GP and were offered regular reviews to check their health and medicines needs were being met.
  • For patients with the most complex needs, the named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care.
  • Patients with multiple long-term conditions were reviewed at one appointment where possible.

Families, children and young people

Good

Updated 15 September 2016

The practice is rated as good for the care of families, children and young people.

  • Systems were in place to identify children at risk. The practice had a dedicated child safeguarding lead and staff were aware of who this was. The practice was working with the health visitor to strengthen links including inviting the health visitor to attend their regular community support team meetings.
  • Vaccination rates for childhood immunisations were in line with local averages.
  • Patients told us that children and young people were treated in an age-appropriate way and treated as individuals and the premises were suitable for children.
  • Maternity services and baby checks were provided at the practice. Patients could access midwife services from the practice.
  • One of the GP partners sat on the paediatric clinical improvement group for the clinical commission group (CCG) and contributed to the development of local care and referral pathways.

Older people

Good

Updated 15 September 2016

The practice is rated as good for the care of older people.

  • Personalised care was offered by the practice to meet the needs of its older population. The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Longer appointments were also provided for older people on request.
  • The nursing team visited patients who were housebound to facilitate long-term condition reviews at home.
  • Services were provided to a number of older people in nursing homes. Ward rounds were undertaken monthly to ensure patients were regularly reviewed. This work was supported by the practice pharmacists who undertook care home medication reviews. Feedback from one of the nursing homes covered by the practice was positive about the level of engagement demonstrated by the practice.
  • Pharmacists undertook medication reviews for older patients to ensure appropriate monitoring of patients taking multiple medicines.

Working age people (including those recently retired and students)

Good

Updated 15 September 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The needs of the working age population, those recently retired and students had been identified and the practice offered services which were accessible and flexible. For example the practice had introduced telephone triage to enable patients who could not get appointments to speak with a GP via telephone.
  • The practice was proactive in offering online services including appointment booking and online prescription services.
  • A range of health promotion and screening services were offered and promoted that reflected the needs of this age group. Uptake rates for cervical cancer screening, bowel cancer screening and breast cancer screening were in line with local and national averages.
  • A range of services were offered at the practice to facilitate patient access including minor surgery and joint injections.
  • Wireless internet services were provided within the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 September 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • Performance for mental health related indicators was 100% which was 3.1% above the CCG average and 7.2% above the national average.
  • 79.2% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 6.2% below the CCG average and 4.8% below the national average.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

People whose circumstances may make them vulnerable

Good

Updated 15 September 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice nurses and healthcare assistants undertook home visits for patients who were housebound to ensure they received a range of services.
  • Information was available which informed vulnerable patients about how to access local and national support groups and voluntary organisations.
  • Translation services were provided where these were required.
  • In order to effectively support vulnerable patients, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care. Community support team meetings were held every six weeks.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours. Safeguarding concerns were regularly discussed at the weekly multidisciplinary meetings.
  • The practice had identified 6% of their patient list as carers and offered support including annual flu vaccinations.